Complications In Geriatric Patients Research Articles

Untreated OSA and Worsening Psychotic Symptoms in a Geriatric Patient with Schizophrenia: A Case Study

<h3>Introduction</h3> In addition to being a debilitating mental disorder, schizophrenia comes with a host of medical comorbidities, that can shorten the lifespan of those living with this illness by 10-25 years. Among these comorbidities is obstructive sleep apnea (OSA), which studies have shown to be more prevalent among patients with schizophrenia, even when controlling for gender, age, other comorbidities, and duration of antipsychotic use. The treatment of schizophrenia and its comorbidities in advanced age is an important consideration in geriatric psychiatry, as the number of patients living with schizophrenia over the age of 60 has been estimated to reach 10 million worldwide by 2050. However, there is limited research on the clinical management of OSA as a complication in geriatric patients with schizophrenia. Here we present the case of a patient with longstanding schizophrenia complicated by obstructive sleep apnea. <h3>Methods</h3> Patient was assessed and followed in a Veterans Hospital-associated long-term care facility by a geriatric psychiatry consultation-liaison service with the assistance of a multidisciplinary team. Here, we present the case and offer a review of the current literature surrounding schizophrenia and obstructive sleep apnea in the geriatric population. <h3>Results</h3> This is a case report of Mr. G, a 78-year-old man with a psychiatric history of schizophrenia and medical comorbidities of lymphedema, morbid obesity, and obstructive sleep apnea. Mr. G was diagnosed with schizophrenia in his early 20s during military service and was maintained on psychotropics for many years with a high degree of functioning, including being able to hold several "odd jobs" and live relatively independently. Throughout his life, Mr. G described baseline auditory hallucinations that were often a nuisance but disappeared when talking to others. As Mr. G got older, he sustained several injuries that made it more difficult for him to live independently, and he was moved into an ALF. Here, his course has been complicated by chronic obstructive sleep apnea likely precipitated by morbid obesity. The case is further complicated by the fact that Mr. G has an intense aversion to wearing masks and has failed multiple trials of CPAP mask. In this context, he has described a worsening of the auditory hallucinations in frequency and intensity, and also in his own affective response to the hallucinations- namely, he is more distressed by them now than he was as a young man. Furthermore, this change has not been responsive to titration in antipsychotics or psychotropic augmentation. <h3>Conclusions</h3> This case demonstrates the need for further research into the relationship between obstructive sleep apnea and schizophrenia, particularly in alternative clinical options. Multiple epidemiological studies have found that OSA is highly prevalent in patients with schizophrenia, and a recent pilot study found that treatment with CPAP improved cognition in patients with schizophrenia. Of particular interest, a recent retrospective case-control study showed similar adherence to CPAP between patients with schizophrenia and control groups. However, it must be noted that although adherence to CPAP was not markedly different from control groups, it was still only approximately 36% after the one-year mark, indicating the need for further development into treatment modalities and adherence measures for those living with schizophrenia, particularly in the geriatric population. <h3>This research was funded by</h3> No Funding Sources to Report

Cardiac complications in a geriatric population hospitalized with COVID-19: The OCTA-COVID cohort

PurposeThe geriatric population is especially vulnerable to coronavirus disease (COVID-19) and its potential complications. We sought to analyze the incidence of cardiological complications in an elderly population hospitalized for COVID-19. MethodsA prospective observational longitudinal that included patients ≥75 years of age with diagnosis of COVID-19 admitted to the Geriatric Department from March to May 2020. Epidemiological, geriatric, clinical and laboratory test variables were collected. Cardiovascular events, including de novo atrial fibrillation (AF), acute coronary syndrome (ACS), congestive heart failure (CHF), pulmonary embolism and in-hospital death, were documented. A follow-up was carried out at 12 months through a telephone interview as well as using electronic medical records, collecting cardiac events and mortality. Results305 patients were included; 190 (62.3%) were female, with median age of 87 years (interquartile range (82–91)). More than half of the patients had a history of cardiac disease, with AF being the most common and affecting 85 (27.9%) patients. During hospitalization, 112 (36.7%) patients died. Eighty-nine (29.2%) patients presented cardiac complications. Acute heart failure was the most prevalent (46; 15.1%), followed by new-onset AF (20; 6.5%), pulmonary embolism (17; 5.6%), and ACS (5; 1.6%). Patients with cardiac complications had a longer hospital stay (p<0.001). During follow-up, 29 (15.1%) died, and 40 (20.8%) patients had a cardiovascular event being CHF the most prevalent complication (16.7%). ConclusionThe incidence of cardiovascular complications in geriatric patients is high and is associated with a longer hospital stay. CHF was the most frequent event, followed by AF.

S1334 Do Geriatric Patients Admitted With a Primary Diagnosis of Celiacs Disease Have a Higher Rate of Complications and Mortality Compared to Their Younger Counterparts?

Introduction: As the incidence of Celiac disease in the geriatric population increases, it is important to understand the disease course and specific complications they may be predisposed. The nuanced symptomatic presentation in the elderly can lead to severe complications as a result of delayed diagnosis. The aim of this study was to determine the rate of common complications and mortality of elderly patients as compared to younger patients admitted to the hospital with a primary diagnosis of Celiac disease. Methods: The National Inpatient Sample 2001-2013 database was queried for patients with a diagnosis of Celiac Disease using International Classification of Diseases, Ninth Revision (ICD-9) codes. Myocardial Infarctions, Pneumonia, Urinary Tract Infections, and Acute Renal Failure were identified with their respective ICD-9 codes. A chi-square analysis was performed to determine variables to be included in a multivariable analysis. A binary logistic regression analysis was used to examine demographic and other important variables, with a significance level of P < 0.001. Results: A total of 87,823 patients were identified with Celiac, of which 25,818 (29.4%) were age 65 or older. After incorporating demographic variables and social variables, such as biological sex, the geriatric population had a significantly higher likelihood of having a myocardial infarction (OR = 2.82), pneumonia (OR = 1.72), urinary tract infection (OR = 1.61), malnutrition (OR = 1.19), and acute renal failure (OR = 2.18). Geriatric patients with Celiac Disease had a significantly higher likelihood of dying during the hospital stay (OR = 10.24). Conclusion: There are many age-related differences in the presentation and clinical course of Celiac disease between the younger adult and geriatric population. The elderly population was found to be more likely to experience life-threatening complications as a result of Celiac disease. A greater understanding of factors contributing to the more complicated clinical courses of Celiac disease in the elderly is needed to improve quality of life and morbidity and mortality in this population. The markedly high likelihood of mortality in this population should be further investigated to prevent treatable causes of death.Figure 1.: Predictors of Complications in Geriatric Patients Admitted Primarily for Celiac Disease.

A case-control study on thyroid surgery in geriatric patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; With the progressive aging of the population, thyroid pathology with surgical indication occurs at increasingly advanced ages. The authors aim was to analyze the forms of presentation of thyroid disease and rate of complications of thyroid surgery performed in geriatric patients and to compare it to the same parameters in younger patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a 7 year retrospective case-control study, with patients who underwent thyroid surgery. The study group included patients above 65 years old and a control group under 65 years old, who underwent thyroidectomy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 81 patients were included. The mean volume of thyroid nodules at presentation was significantly higher in the study group compared to the control group, regarding the disease presentation, it was an accidental imaging finding in 59% of patients of the study group, while in the control group there were more compressive symptoms at presentation. The rate of postoperative complications in geriatric patients was 29% versus 20% in the control group, a difference that was not statistically significant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Given the high number of comorbidities presented by geriatric patients, the symptoms of thyroid disease can be undervalued, explaining the greater number of accidental imaging findings and the greater volume of nodules at the time of surgery. Our results show that geriatric thyroid surgery is safe and has acceptable postoperative morbidity. The detection of thyroid pathology in these patients is a greater challenge, which can obscure symptoms, delay diagnosis and worsen prognosis.&lt;/p&gt;

The influence of frailty on postoperative complications in geriatric patients receiving single-level lumbar fusion surgery.

This study evaluates the influence of patient frailty status on postoperative complications in those receiving single-level lumbar fusion surgery. The nationwide readmission database was retrospectively queried between 2016 and 2017 for all patients receiving single-level lumbar fusion surgery. Readmissions were analyzed at 30, 90, and 180 days from primary discharge. Demographics, frailty status, and relevant complications were queried at index admission and all readmission intervals. Complications of interest included infection, urinary tract infection (UTI), posthemorrhagic anemia, inpatient length of stay (LOS), and adjusted all-payer costs. Nearest-neighbor propensity score matching for demographics was implemented to identify non-frail control patients with similar diagnoses and procedures. The analysis used nonparametric Mann-Whitney U testing and odds ratios. Comparing propensity-matched cohorts revealed significantly greater LOS and total all-payer inpatient costs in frail patients than non-frail patients with comparable demographics and comorbidities (p < 0.0001 for both). Furthermore, frail patients encountered higher rates of UTI (OR: 3.97, 95%CI: 3.21-4.95, p < 0.0001), infection (OR: 6.87, 95%CI: 4.55-10.86, p < 0.0001), and posthemorrhagic anemia (OR: 1.94, 95%CI: 1.71-2.19, p < 0.0001) immediately following surgery. Frail patients had significantly higher rates of 30-day (OR: 1.24, 95%CI: 1.02-1.51, p = 0.035), 90-day (OR: 1.38, 95%CI: 1.17-1.63, p < 0.001), and 180-day (OR: 1.55, 95%CI: 1.30-1.85, p < 0.0001) readmissions. Lastly, frail patients had higher rates of infection at 30-day (OR: 1.61, 95%CI: 1.05-2.46, p = 0.027) and 90-day (OR: 1.51, 95%CI: 1.07-2.16, p = 0.020) readmission intervals. Patient frailty status may serve as an important predictor of postoperative outcomes in patients receiving single-level lumbar fusion surgery.

An Analysis of the Risk Factors for Postoperative Complications and Their Effects on Hospital Stay in Taiwanese Geriatric Surgical Patients.

Surgical outcomes and complications in geriatric patients may be affected due to their increased number of underlying diseases. This study was conducted to evaluate the risk factors for postoperative complications and their effects on hospital stay in geriatric surgical patients (aged ≥ 80 years). A total of 404 geriatric patients (aged ≥ 80 years) who underwent noncardiac surgery were enrolled in this study. Their preoperative, perioperative, and postoperative data were collected and subjected to univariate and multivariate analyses to calculate the odds ratio of risk factors. The risk of discharge was analyzed by calculating the hazard ratio to evaluate their relationship with postoperative complications. Approximately three-fourths (76.0%) of the patients had hypertension preoperatively, and 5.9% of them developed at least one postoperative complication. Respiratory disorders were the most frequent postoperative complications. Multivariate analysis revealed emergency surgery, preoperative renal diseases, preoperative anemia, and nonextubation as risk factors for postoperative respiratory complications. Intraoperative estimated blood loss of ＞ 500 mL and intraoperative low blood pressure were identified as risk factors for postoperative neurological complications. Intraoperative hypothermia was found to be a risk factor for postoperative renal complications. Postoperative respiratory complications, postoperative neurological complications, and infection statistically significantly prolonged the length of hospital stay. The in-hospital mortality rate was 1.0%. Patients aged ≥ 80 years under certain conditions need more attention to prevent the development of different types of postoperative complications. Those who did develop postoperative respiratory complications, postoperative neurological complications, and infection might require prolonged hospitalization. Physicians must pay more attention preoperatively to the risk factors that increase postoperative complications.

Predictors of 30-day postoperative systemic complications in geriatric patients undergoing elective brain tumor surgery

Little evidence exists to guide the preoperative selection of elderly brain tumor patients who are fit for surgery. We aimed to evaluate the safety of brain tumor resection in geriatric patients and identify predictors of postoperative 30-day systemic complications. We conducted a retrospective cohort study of 212 consecutive patients at or above the age of 60 years who underwent elective brain tumor resection between 2007 and 2017. The primary outcome measures analyzed were perioperative systemic complications within 30 days after the operation. A total of 212 geriatric brain tumor patients were included. Fifty-two (24.5%) had a 30-day systemic complication. Among them, 29 (13.7%) had systemic infections, 13 (6.1%) had perioperative seizures, 10 (4.7%) had syndrome of inappropriate antidiuretic hormone secretion (SIADH), five (2.4%) had deep venous thrombosis (DVT), four (1.9%) had perioperative stroke, three (1.4%) had acute myocardial infarction (AMI) and three (1.4%) had central nervous system (CNS) infections. One patient (0.5%) died. Perioperative stroke was predicted by previous stroke (p = 0.040), chronic liver disease (p < 0.001) and vestibular schwannoma (p = 0.002 with reference to meningiomas). Perioperative AMI was predicted by co-existing ischemic heart disease (p = 0.031). Systemic infection was predicted by female gender (p = 0.007) and preoperative Karnofsky Performance Scale (KPS) score < 70 (p = 0.019). DVT was predicted by GBM (p = 0.014). In conclusion, brain tumor surgery can be safe in carefully-selected geriatric patients. The risk factors identified in this study would be helpful to select suitable candidates for surgery.

Early Outcomes After Surgical Management of Geriatric Patella Fractures.

Objectives:To report the incidence and risk factors for prolonged hospitalization, discharge to a facility, and postoperative complications in geriatric patients who underwent surgery for patella fracture.Design:Retrospective database review.Setting:The American College of Surgeons—National Surgical Quality Improvement Program (NSQIP) collects data from 600 hospitals across the United States.Patients/Participants:NSQIP patients over 65 years of age with patella fractures.Intervention:Surgical fixation of patella fracture including extensor mechanism repair.Main Outcome Measurements:Prolonged hospitalization, discharge to a facility, and 30-day post-operative complications.Results:1721 patients were included in the study. The average age was 74.9 years. 358 (20.8%) patients were male. 122 (7.1%) patients had a length of stay greater than 7 days. Factors associated with prolonged length of stay include pre-existing renal failure, need for emergent surgery, and time to surgery greater than 24 hours from admission. 640 patients (37.2%) of patients were discharged to a facility after surgery. Discharge to facility was associated with age >77 years, obesity, anemia, thrombocytopenia, pre-operative SIRS, and CCI > 0.5. Admission from home decreased the odds of discharge to a facility. The most common postoperative complications in this population were unplanned readmission (3.4%), unplanned reoperation (2.7%), surgical site infection (1.1%), mortality (1.0%), venous thromboembolism (0.8%), and wound dehiscence (0.2%). Complication rates increased with anemia and ASA class IV-V.Conclusions:Geriatric patients undergoing operative intervention for patella fractures are at high risk for prolonged hospitalization, discharge to facility, unplanned readmission or reoperation, and surgical site complications in the first 30 days following surgery. This study highlights modifiable and non-modifiable risk factors associated with adverse events. Early recognition of these factors can allow for close monitoring and multidisciplinary intervention in the perioperative period to improve outcomes.Level of Evidence:Prognostic level III.

Is the 5-factor modified Frailty Index a prognostic marker in geriatric ankle fractures?

The 5-factor modified Frailty Index (mFI-5), which is the latest version of the Frailty Index, is a tool that calculates the risk of complications after treatment by scoring the comorbidity status of the patient. The aim of this study was to evaluate the efficacy of the mFI-5 in predicting complications in geriatric patients with an ankle fracture. A retrospective examination was made of a total of 94 patients aged >65 years who were treated for an ankle fracture in our hospital between 2015 and 2020. Weber type A, B, and C fractures were included in the study. For each patient, the mFI-5 was calculated for the comorbidity status of diabetes, chronic obstructive pulmonary disease, congestive heart failure, hypertension requiring drugs, and non-independent functional status. Multivariance logistic regression analysis was used to evaluate the mFI-5 points as a predictor of negative outcomes. The mFI-5 was observed to be effective in the prediction of the complications of hospital re-admission, wound site infec-tion, life-threatening medical complications, and the presence of any complication (p<0.05). In the prediction of whether or not there was any complication, the mFI-5 was determined to be a more effective tool than body mass index, American Society of Anesthesiol-ogist, age, length of stay in hospital, and duration of operation (p<0.05, OR=2.726, 95% Confidence Interval=1.285-5.783). The mFI-5 is a sensitive tool for the prediction of complications which may develop following geriatric ankle frac-ture. The five comorbidities which constitute the mFI-5 are easily obtained from the patient anamnesis, and this renders it a practical clinical tool to identify high-risk patients, determine the preoperative risks, and improve the health-care service.

Patterns of use of drugs in hypertension in geriatric patients in the department of medicine at tertiary care hospital of Nepal.

Introduction: In Nepal, the prevalence of hypertensive in elderly population is 41.7% aged 65 years or more. Hypertension increases with age leading to arterial stiffness and endothelial dysfunction. The prevalence of hypertension is 20% of urban populations. Blood pressure control with the use of antihypertensive drugs reduces cardiovascular complications in geriatric patients.&#x0D; Objectives: The objective of our study is to know the various patterns of drugs used in geriatrics hypertensive patient along with their co-morbidities and to know the most commonly used antihypertensive drug in geriatric patient.&#x0D; Methodology: It was a hospital based cross sectional study involving 130 patients based on non-probability sampling. The study involved the hypertensive elderly patients of age &gt; 65 years prescribed with antihypertensive drugs. Data were collected from patients attending outpatient department of medicine . Medical and nursing records were analyzed for patient’s characteristics (e.g. age, gender), systolic and diastolic BP readings, number of drugs, monotherapy, combination therapy, co morbidities. Data were analysed by using SPSS version 20.&#x0D; Results: The total 130 geriatric patients under treatment with antihypertensive drugs were included, in which 55.38% were male and 44.62% were female. The total numbers of antihypertensive drugs prescribed were 212 either as monotherapy or as a component of a combination therapy. The average number of drugs prescribed per patient was found to be 1.66. Among these drugs 56.92% were prescribed as monotherapy,26.92% were prescribed as two drugs combination therapy,12.30% were prescribed as three drugs combination and 3.84% were prescribed as four drugs combination therapy. calcium channel blockers (amlodipine )was the most commonly prescribed antihypertensive.&#x0D; Conclusion: The study showed male patient were more predominant hypertensive compare to female. calcium channel blockers group of drugs in which amlodipine was the most commonly prescribed antihypertensive drug and more than half of the patients were in monotherapy.

The role of frailty in geriatric cranial neurosurgery for primary central nervous system neoplasms

Frailty is a clinical state of increased vulnerability due to age-associated decline and has been well established as a perioperative risk factor. Geriatric patients have a higher risk of frailty, higher incidence of brain cancer, and increased postoperative complication rates compared to nongeriatric patients. Yet, literature describing the effects of frailty on short- and long-term complications in geriatric patients is limited. In this study, the authors evaluate the effects of frailty in geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm. The authors conducted a retrospective cohort study of geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm between 2010 and 2017 by using the Nationwide Readmission Database. Demographics and frailty were queried at primary admission, and readmissions were analyzed at 30-, 90-, and 180-day intervals. Complications of interest included infection, anemia, infarction, kidney injury, CSF leak, urinary tract infection, and mortality. Nearest-neighbor propensity score matching for demographics was implemented to identify nonfrail control patients with similar diagnoses and procedures. The analysis used Welch two-sample t-tests for continuous variables and chi-square test with odds ratios. A total of 6713 frail patients and 6629 nonfrail patients were identified at primary admission. At primary admission, frail geriatric patients undergoing cranial neurosurgery had increased odds of developing acute posthemorrhagic anemia (OR 1.56, 95% CI 1.23-1.98; p = 0.00020); acute infection (OR 3.16, 95% CI 1.70-6.36; p = 0.00022); acute kidney injury (OR 1.32, 95% CI 1.07-1.62; p = 0.0088); urinary tract infection prior to discharge (OR 1.97, 95% CI 1.71-2.29; p < 0.0001); acute postoperative cerebral infarction (OR 1.57, 95% CI 1.17-2.11; p = 0.0026); and mortality (OR 1.64, 95% CI 1.22-2.24; p = 0.0012) compared to nonfrail geriatric patients receiving the same procedure. In addition, frail patients had a significantly increased inpatient length of stay (p < 0.0001) and all-payer hospital cost (p < 0.0001) compared to nonfrail patients at the time of primary admission. However, no significant difference was found between frail and nonfrail patients with regard to rates of infection, thromboembolism, CSF leak, dural tear, cerebral infarction, acute kidney injury, and mortality at all readmission time points. Frailty may significantly increase the risks of short-term acute complications in geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm. Long-term analysis revealed no significant difference in complications between frail and nonfrail patients. Further research is warranted to understand the effects and timeline of frailty in geriatric patients.

Preoperative Pulmonary Evaluation and Evaluation of Postoperative Pulmonary Complications in Geriatric Patients Undergoing Spinal Surgery

Preoperative Pulmonary Evaluation and Evaluation of Postoperative Pulmonary Complications in Geriatric Patients Undergoing Spinal Surgery

USE OF BIOCHEMICAL MARKERS IN EARLY PREDICTION OF DELIRIUM TREMENS IN GERIATRIC PATIENTS WITH ALCOHOL USE DISORDERS

Introduction Delirium Tremens (DT) may be an underrecognized entity in the elderly, leading to both morbidity and mortality in patients with alcohol use disorders (AUDs). The clinical institute of withdrawal assessment for alcohol- revised (CIWA-Ar) protocol has been established and widely used in hospital systems for management and prevention of further complications in geriatric patients with AUDs. The CIWA- Ar score is also often used in disposition decision making with patients being discharged from the emergency room for outpatient detoxification if score is Methods The authors conducted a literature review regarding identification and management of delirium tremens in geriatric patients with a history of alcohol use disorder.We searched PubMed using keywords and phrases including: delirium tremens, alcohol withdrawal, chronic alcoholism, CIWA, alcohol effect on CNS, treatment of delirium tremens, treatment of alcohol withdrawal. Results If early identification of delirium tremens and appropriate disposition is the goal that small rural healthcare settings should aim for then it is critical that early predictors of alcohol withdrawal seizures and delirium tremens are clearly established. The overdependence on physical markers such as pulse and blood pressure may be counterproductive in psychiatric units, which lack adequate nursing staff to constantly monitor these vitals. The CIWA-Ar protocol, although validated and useful in many patients with alcohol withdrawal in the general hospital setting, does have drawbacks. Its efficacy and use has not been as successful in patients with complex medical illnesses as well as post-surgical patients. Conclusions Established laboratory tests such as γ-glutamyltransferase (GGT) activity, aspartate aminotransferase (AST) activity, high-density lipoprotein cholesterol (HDL-C) content of serum, and erythrocyte mean corpuscular volume (MCV) are established markers of alcohol intake and provide valuable measures of recent alcohol intake and abstinence. In the same light, homocysteine, potassium levels and platelet counts should be integral part of the assessment of persons with hazardous alcohol consumption. The employment of biochemical markers, electrolyte assessment and BP monitoring along with basic history taking and examination skills in decision making regarding disposition and treatment should form the basis of alcohol use disorder management protocols especially in low resource settings with limited nursing support. This research was funded by: No funding was received for this poster presentation

Cerebrospinal Fluid Levels of Interleukin-8 in Delirium, Dementia, and Cognitively Healthy Patients.

Delirium is a common and serious complication in geriatric patients. The pathophysiology of delirium is not known. The objective of the current study was to test the hypothesis that cerebrospinal fluid (CSF) levels of inflammatory markers at the time of spinal anesthesia for hip surgery are associated with delirium. In total 133 hip fracture patients and 125 cognitively healthy controls undergoing elective surgery, together with 73 Alzheimer's disease (AD) dementia patients, were recruited at Oslo University Hospital and Diakonhjemmet Hospital, Oslo, Norway. Delirium was evaluated daily in hip fracture patients by the Confusion Assessment Method (CAM). Depression was evaluated by Cornell Scale for Depression in Dementia (CSDD). Tumor necrosis factor alpha (TNF-α), interleukin-1beta (IL-1β), and interleukin-8 (IL-8) levels were measured in CSF using a Mesoscale Discovery (MSD) immunoassay. Hip fracture patients had significantly higher IL-8 levels (p < 0.001) compared to cognitively healthy controls or patients with stable AD dementia. Furthermore, preoperative IL-8 levels were significantly higher (p = 0.013) in hip fracture patients who developed delirium (incident delirium) after surgery as compared to patients with no delirium. However, subgroup analyses showed that IL-8 levels were only significantly higher in delirium patients without dementia (p = 0.006). In contrast, depression subgroup analysis showed that IL-8 concentration was significantly higher (p = 0.002) in delirium patients with depression. Both TNF-α and IL-1β were undetected in most patients. Our study suggests that IL-8 levels are associated with delirium onset and that underlying depression or dementia influences IL-8 levels.

The Effect of Abdominal Massage on Enteral Complications in Geriatric Patients.

Introduction and PurposeGeriatric patients, who are fed by nasogastric tube (NG), may suffer from complications. Therefore, this study was conducted to evaluate the effect of abdominal massage on Gastric residual volume (GRV), distension, vomiting, and defecation in geriatric patients, who were hospitalized in intensive care unit and fed by NG.MethodsThe quasi-experimental study was conducted in intensive care units. The researcher applied abdominal massage to patients in the intervention group (n = 30) twice a day for 15–20 minutes before feeding. The data of the study were collected by using a questionnaire and a parameter questionnaire.ResultsGRV decreased significantly in the intervention group and increased significantly in the control group (p < 0.05). The frequency of defecation significantly increased in intervention group (p < 0.05). It was found that there was no positive effect of abdominal massage on vomiting (p > 0.05).ConclusionIt was observed that while abdominal massage reduced high GRV and distension incidence, it increased the incidence of defecation.

Postoperative complications in geriatric patients in vascular surgery: A tertiary care center experience

Postoperative complications in geriatric patients in vascular surgery: A tertiary care center experience

Perioperative Complications Associated with Severity of Anemia in Geriatric Patients Undergoing Spinal Procedures

To investigate preoperative baseline anemia, stratified by severity as a function of hematocrit level, as a risk factor for perioperative complications in geriatric patients undergoing spinal procedures. Previous literature has examined the impact of anemia on risk for complications and adverse outcomes in patients undergoing elective spinal procedures. However, there is a paucity of literature analyzing the impact of anemia in the geriatric population, specifically. The American College of Surgeons-National Surgical Quality Improvement Database was used to identify patients older than 65 years who had undergone elective spinal procedures and were subsequently stratified into 3 separate cohorts based on hematocrit levels: severe/moderate (hematocrit level <30%), mild (30%-37%), and no anemia (>38%). These patient samples were then analyzed using multivariate analyses to assess severity of anemia as a risk factor for complications in elderly patients undergoing spinal procedures. When anemia classes were analyzed as separate independent risk factors for complications, mild anemia (class II) was a significant risk factor for the same complications as moderate/severe anemia (class III/IV), with the exception of 2 complications, compared with nonanemic patients. Mild anemia was independently associated with wound dehiscence (odds ratio, 1.521; 95% confidence interval, 1.126-2.054; P= 0.006), whereas moderate/severe anemia did not show an increased risk for wound dehiscence. However, moderate/severe anemia independently increased the risk for deep venous thromboembolism (odds ratio, 1.437; 95% confidence interval, 1.028-2.011; P= 0.034), compared with mild anemia. Both categories of anemia independently increased the risk for additional complications such as deep incisional surgical site infection, organ/space surgical site infection, pneumonia, unplanned intubation, ventilator dependence, progressive renal insufficiency, acute renal failure, urinary tract infections, cardiac arrest, myocardial infarctions, blood transfusions, systemic sepsis, reoperation, extended length of stay of ≥5 days, unplanned readmission, and mortality. This study indicated that patients with preoperative baseline anemia were at risk for requiring transfusions, renal failure, and infectious complications. Physicians should be cognizant of anemia as a risk factor affecting numerous perioperative complications and adverse outcomes to work toward improving health-related quality of life.

Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis.

Previous meta-analyses assessing anesthetic techniques in adult patients undergoing hip fractures surgery are available. However, whether the anesthetic technique is associated with risk of mortality and complications in geriatric patients with hip fractures remains unclear. This study was conducted to assess postoperative outcomes of anesthesia technique in geriatric patients undergoing hip fracture surgery. Cochrane Library, PubMed, EMBASE, MEDLINE, CNKI, and CBM were searched from inception up to May 25, 2018. Observational studies and randomized controlled trials (RCTs) that assessed the perioperative outcomes of technique of anesthesia (general or regional [epidural/spinal/neuraxial]) in geriatric patients (≥60 years old) undergoing hip fracture surgery were included. Two investigators independently screened studies for inclusion and performed data extraction. Heterogeneity was assessed by the I and Chi-square tests. The odds ratio (OR) of the dichotomous data, mean difference (MD) of continuous data, and 95% confidence intervals (CI) were calculated to assess the pooled data. Eleven retrospective and 2 RCTs were included. There was no difference in 30-day mortality (OR = 0.96; 95% CI 0.86-1.08; P = .51) between the general and regional anesthesia groups. In-hospital mortality (OR = 1.26; 95% CI 1.17-1.36; P < .001), acute respiratory failure (OR = 2.66; 95% CI 2.34-3.02; P < .001), length of hospital stay (MD = 0.33; 95% CI 0.24-0.42; P < .001), and readmission (OR = 1.09; 95% CI 1.01-1.18; P = .03) were significantly reduced in the regional anesthesia group. Pneumonia (OR = 0.99; 95% CI 0.91-1.07; P = .79), heart failure (OR = 0.97; 95% CI 0.86-1.09; P = .62), acute myocardial infraction (OR = 1.07; 95% CI 0.99-1.16; P = .10), acute renal failure (OR = 1.32; 95% CI 0.97-1.79; P = .07), cerebrovascular accident (OR = 1.08; 95% CI 0.82-1.42; P = .58), postoperative delirium (OR = 1.51; 95% CI 0.16-13.97; P = .72), and deep vein thrombosis/pulmonary embolism (OR = 1.42; 95% CI 0.84-2.38; P = .19) were similar between the two anesthetic techniques. General anesthesia is associated with increased risk of in-hospital mortality, acute respiratory failure, longer hospital stays, and higher readmission. There is evidence to suggest that regional anesthesia is associated with improved perioperative outcomes. Large RCTs are needed to explore the most optimal anesthetic techniques for geriatric patients with hip fractures before drawing final conclusions. CRD42018093582.

Implications of Clozapine Complications in Geriatric Patients with Type II Diabetes Mellitus

Second-generation antipsychotics, have known metabolic side effects; specifically, clozapine is implicated in worsening or causing hyperglycemia, hypercholesterolemia and weight gain. Recently, there has been an increased interest in the safe use of clozapine in patients with diabetes. In March 2018, a 65-year-old female with a diagnosis of schizophrenia was admitted for inpatient hospitalization to a psychiatric hospital in Buffalo, NY for further stabilization after receiving two months of treatment at a comprehensive psychiatric emergency program (CPEP). Her medical diagnoses included type 2 diabetes mellitus (T2DM), vitamin D deficiency, hyperlipidemia, glaucoma, and constipation. Upon admission, the patient was continued on clozapine, and fluphenazine for treatment of schizophrenia. Her medical medications upon admission included acetaminophen, cholecalciferol, multivitamin, and timolol maleate eye drops. Low blood glucose results at the beginning of her hospitalization led to discontinuation of fingerstick blood glucose readings as the patient was prescribed a controlled diet, and her most recent hemoglobin A1c (HgbA1c) level was 6.8% on March 23, 2018. Clozapine was initiated and titrated over the next four months of inpatient treatment. The patient became psychiatrically stable and was prepared for discharge. During her final medical and psychiatric evaluation laboratory findings included a HgbA1c of 14.4% - a total increase of 7.6% over the course of 31 weeks. Clozapine is implicated in causing health-related complications that include agranulocytosis, seizures, constipation, and hypersalivation, as well as, metabolic side effects such as weight gain and hyperglycemia. Clozapine can also exacerbate pre-existing diabetes or lead to a new diagnosis of T2DM. If not controlled, these metabolic effects can lead to serious long-term consequences. Clozapine was prescribed prior to hospital admission and further titrated during the patient’s hospitalization at a long-term psychiatric facility. The patient had a diagnosis of T2DM but did not receive pharmacotherapy due to well controlled blood glucose and a HgbA1c level within goal. Pending discharge, a final psychiatric and medical examination determined that the patient’s HgbA1c had more than doubled. The significant increase in HgbA1c in a geriatric patient with diet-controlled T2DM confirms that psychiatric medication changes can cause dysregulation of T2DM. Further research is needed to explore any potential increased likelihood, or magnitude of effect, of these drug induced metabolic consequences in older adults.

Delirium in geriatric urology patients

Delirium is acommon but often undiagnosed complication in geriatric patients following amajor or minor operation. With 14-56% in patients over 70 years of age, it is one of the most frequent complications seen in hospitals. The link between the prescription of drugs with antimuscarinic effects and cognitive disturbance is also well known. Recognizing the presence of delirium and the criteria to establish the diagnosis of delirium will improve aclinician's ability to detect this complication. Treating delirium with non-pharmacologic, reduces the incidence and side effects of postoperative delirium. The purpose of this article is to describe the diagnosis and treatment of postoperative delirium. Asudden rise following fluctuating symptoms with decreased attentiveness, awareness and thinking are typical symptoms of delirium. The organic origin is not focused and must be considered. Transurethral resection (TUR) of the prostate and the bladder can increase the risk of bleeding, delirium and TUR syndrome. As simple instruments to assess signs and symptoms, the Clinical Assessment Method (CAM) and the Nurses Delirium Screening Scale (Nu-DESC) in the clinical setting are well examined. Preoperatively screening and execution of ageriatric assessment to detect vulnerable elderly could be afirst step in reduction of complication. Regularly screening for delirium reduces the pre-, post-, and perioperative complications in patients with delirium.